| NPI | 1538994371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110010369) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 363AM0700X) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-10-29 |